The inspection took place on 28, 29 June and 1 July 2016 and was unannounced on the first day. This was the third rated inspection for this service which had previously been rated inadequate in November 2014. In March 2015 we carried out a focused inspection and a further comprehensive inspection took place in June 2015. We found improvements had been made, but further improvements were required to be implemented and the service was rated as requires improvement. You can read the report from our last inspections, by selecting the 'all reports' link for ‘Laureate Court’ on our website at www.cqc.org.uk.’ Laureate Court provides residential and nursing care for up to 82 people who are living with dementia and other mental health problems. The home has three units; Byron and Shelley both provide nursing care and Keats which provides residential care. The home is located close to Rotherham town centre. At the time of our inspection there were 56 people using the service, 26 people receiving nursing care and 30 people in receipt of residential care.
The service did not have a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons.’ Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A manager had been appointed by the provider in January 2016. This person was present throughout the inspection.
During this inspection we looked to see if improvements had been embedded in to practice from our last inspection. We found insufficient progress had been made. We identified seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We spoke with the manager and regional manager who told us the reason was due to the change of management company which had taken place in January 2016, and this had had an impact on progressing the service. However, the provider had remained the same.
During our inspection we observed people had to wait at times for assistance and staff were not always present in communal areas to ensure people’s safety. Staff and relatives we spoke with told us at certain times they could do with more staff to ensure people’s needs were met in a timely way and maintain their safety.
Systems were in place to ensure people received their medications in a safe and timely way from staff who had been trained to carry out this role. However, we identified these had not always been followed and people did not always receive their medication as prescribed.
We found some people, who were prescribed medication to be given as and when required, were given this regularly as a means to control their agitation. Other methods to monitor and manage anxiety had not been considered.
People were not protected against the risks associated with infection prevention and control. Safe procedures were not followed.
Staff we spoke with were knowledgeable about safeguarding people from abuse. They told us they would report any concerns straight away.
The provider had a system in place to ensure people were recruited in a safe way. The manager was currently working through staff files to ensure that all correct documentation was present.
Staff we spoke with told us communication was poor; there was a lack of staff meeting, supervision and leadership. Staff morale was very low which was impacting on the people who used the service.
Staff told us that they had not received much training until recently. Most training was completed via eLearning although some recent training sessions had been arranged face to face. The provider's training records showed staff training was required.
People were not always supported to eat and drink sufficient amounts to maintain a balanced diet. Some mealtimes were disorganised which led to staff not ensuring people received adequate drinks and meals. We saw lots of plates being taken from people without them eating much, but this was not addressed by staff.
We looked at people’s care plans and found their needs were not always addressed and health care services not considered or used when needs changed. For example we found one person had lost considerable weight over three months, there was no nutritional care plan and there had been no referral to a dietician.
The manager was aware of their duties in relation to the MCA 2005, and had arranged for best interest meetings to take place where required.
We observed staff interacting with people who used the service and found that most of the time interactions were task orientated. There were several occasions where there was a lack of regard for people’s dignity and respect.
We checked people’s care records that were using the service at the time of the inspection. We found that care plans had not always identified people's care needs. Where care plans had been reviewed notes had been recorded in the evaluation record and not the care plan. This made it confusing to the reader as to what people’s current care needs were.
The home employed two activity co-ordinators whose role it was to arrange social stimulation for people. We received positive feedback from people living on Keats unit, but negative feedback from Shelley and Byron. In the main activity events took place on Keats unit, which left the other two units with little or no social stimulation.
The service had a complaints procedure and people told us they would tell staff if they had a concern although some people were not confident that things would be resolved. We looked at records and found no evidence to suggest that complaints had been investigated.
We found some systems were in place to monitor the quality of service provision. However, these were not effective and did not always identify concerns. Where concerns had been identified there was little evidence to show what actions had been taken to address them. Some concerns identified at the beginning of March 2016 were still awaiting action.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.